10, p = .15; see Figure 3). Finally, age of onset of khat use was inversely correlated with frequency of khat use (hours per session: r = ?.31, p < .01; times per week: r = ?.34, p < .001; selleck catalog years of khat use: r = ?.28, p < .01). Figure 3. A gender �� smoking status interaction in the number of khat sessions held per week. Smoking status (occasional or daily) was associated with khat use among women while this was not the case with men as found by simple effects tests. DISCUSSION More than 70% of khat users in the current sample of Yemeni adults reported that they consume khat on a regular basis. The average age of onset of khat use was 17, and these individuals spend 5hr a day chewing almost every day. These confirm previous studies (Al-Motarreb et al., 2002; The World Bank, 2007).

Also as expected, men reported that they consume khat and tobacco more intensely and frequently than women, supporting that these substances are more widely accepted among men as compared with women in Middle Eastern countries (Maziak, 2002; The World Bank, 2007). The current study found that men and women use different tobacco products during a khat session. Men were more likely to smoke cigarettes, whereas women tended to smoke waterpipe. Studies have reported gender differences in social perception of cigarette and waterpipe smoking. For example, cigarette smoking is generally considered ��men��s thing�� and viewed as unfavorable behavior for women in Middle Eastern countries (Maziak, 2002). In contrast, waterpipe smoking is generally viewed as more socially positive and trendy as compared with cigarette smoking (Hammal, Mock, Ward, Eissenberg, & Maziak, 2008; Maziak et al.

, 2004). Family attitude toward the use of waterpipe by women is more lenient than its use by men (Maziak et al., 2004). These findings suggest that waterpipe smoking is more culturally accepted than cigarette smoking for women. Another possibility is gender differences in taste perception of khat. Epidemiological data report that female nonusers do not chew khat because of its bitter taste more so than men (The World Bank, 2007). Because aroma and taste are often attributed to the use of waterpipe (Maziak et al., 2004), it is possible that women khat users consume flavored waterpipe to manage the bitterness of the leaves. The findings that 87% of women cited that they smoke only when they chewed khat (vs.

30% of men), while the majority of men (>55%) endorsed that they smoke their first cigarette after Cilengitide breakfast and smoke before going to bed (compared with less than 30% of women) may further suggest that tobacco use among women may be situation specific. Taken together, social, motivational, and psychopharmacological processes may be associated with different patterns of tobacco use between male and female khat users. Our findings extend previous work by pointing out the need to take into account gender differences when examining concurrent use of khat and tobacco.